Tagged: surgery

I’ve been processing the prospect of a hysterectomy for the past year. I’m at the point where I definitely want the surgery and will probably schedule it as soon as I don’t have a bunch more urgent stuff demanding my attention (i.e. when the semester is over). I have to say it’s been an excruciatingly painful aspect of my transition. A few thoughts on where I’m at and how I got here.

Mules are also sterile, and this one is ready for a nap. I guess there’s just something about being between categories. Photo: David Shankbone.

1. Sterility is a really big deal. When I went in to get a prescription for testosterone, my doctor asked me if I wanted to preserve the possibility of having a biological child. I was like, um, yeah, hell no. I was also 21 years old and way more concerned with paying for beer that night than with being a parent someday.

Letting go of the possibility of having a biological child has been the hardest and most heart-wrenching aspect of this experience. I don’t want to use any of the options available to me for having genetic offspring. There are so many reasons for this, I don’t even want to get into it. Suffice to say that even though I don’t want to use what I’ve got–just the prospect makes me queasy–it’s still hard to let it go. It means letting go of the fantasy that I could ever be a biological father. In confronting this reality, I have felt disappointed, cheated, and humiliated. I have felt left out of the great dance of life, a lonely alien. It feels strange to be so sad, yet so repulsed by the options that are open to me.

2. I am in profound denial about my body. I have never accepted the fact that I was born with a female body. I have to admit that I just straight up do not believe it, to this very day. There’s some pretty solid evidence for my view in that I am, you know, a man. Again I ask, WTF God? WTF?

This is a very deep-seated belief that is beyond all logic and is extremely resistant to change. As far as I can tell, I have always carried the worldview that I am male and it seems I always will. This is the reason approaching hysterectomy has been so painful–it has forced me to experience the cognitive dissonance of being transsexual in a whole new horrible way.

My take on this is, to paraphrase Eckhart Tolle, when you can’t accept, accept your non-acceptance. I accept that I am a trans man, that I have a view of my body as male that is not going to change, and that the thing I can change is my body. I accept that I cannot be a good custodian to female reproductive organs. It’s just not realistic for me at all. So a hysterectomy is something I can do for myself and for my health, out of love.

3. Grieving is necessary. I spent a good while feeling heartbroken about my status as soon-to-be-sterile and never having the option to be a biological father. This was an absolutely essential process for me. It’s normal to grieve over this kind of thing, and we need to allow ourselves the space and time to fully go there.

I can now see that a lot of my grief is about lingering shame and pain around being trans, rather than about parenthood (though of some of it really does have to do with parenthood). I have an ingrained belief that being able to father a child has something to do with being a “real man.” I’m still dealing with this; cultural ideas like that are just hard to shake off.

4. Planning a family is about a lot more than gametes. As I began to see the light at the end of the tunnel of my grief, I got a reality check about my hopes to be a parent. Having a child is something I want to do with my wife, obviously, but it’s only recently that I’ve been able to really consider her feelings. In retrospect, I’ve been pretty myopic and selfish about the whole thing; but at the same time, I really could not have gotten to this point without moving through my grief.

Alma has always wanted to adopt and has absolutely zero interest, or really less than zero interest, in ever being pregnant. I can now enjoy the wonderful match we have in this area and feel good about supporting her in her bodily autonomy.

I’m enjoying my new-found clarity about my own feelings, hopes and fears. I’ve come to realize that I actually do not care about having a biological descendant or sharing that connection with a child. I do care very much about being a father someday and I hope to adopt children with my partner. There is a scary vulnerability in this, as I have no idea if it will work out. But it’s real and it’s honest, a genuine dream.

How has your transition impacted your feelings and choices about fertility and parenthood?

I finally got my birth certificate amended. I’d been putting off dealing with it and finally sent in the papers a couple weeks ago. It arrived in the mail, shiny and official. I was born in Massachusetts, and I’d read online that I could expect a birth certificate with my birth name and assigned sex crossed out, and the correct name and sex written in. But when it came it was complete and perfect, just my name and the word male, no nonsense. Opening that envelope had a real thud of finality to it–the very last piece of paper to get changed.

I’m jumping directly into another legal transition of sorts and changing my name again. Alma and I have put a lot of thought into what to do with our last names now that we are married. I’ve decided to take hers. I’m pretty excited about it. I really wanted us to share a name; she is very attached to hers, and I’m not that attached to mine; and we’re not that into hyphenation for a few reasons. Any why shouldn’t a guy take his wife’s name?

So soon I will have changed every single name from what I was born with–first, middle, and last. I’ve managed to keep the same initials, SLB. Taking her name also allows me to make a gesture of cultural solidarity, as she has a very ethnically marked name. She’s converting to Judaism; taking her name is kinda as close as I can get to “converting” to be Chicano.

I’m finally getting ready to seriously pursue a hysterectomy. It’s been a long emotional process–I hope to give it a proper treatment in a post soon. At this point, I feel at ease with my body and my circumstances, and I want the surgery. I’m hoping to get it this summer.

Between these things I’m feeling like my transition is really ending, maybe over. My paperwork is all changed; I’m getting ready for my last surgery; the big changes in my life now aren’t about my transition; shame’s appearances get rarer and rarer. It’s a good feeling, a spacious absence, very quiet.

If the question of whether to take T inspires a lot of indecision and angst, the choice to have top surgery seems more straightforward. I rarely hear transmasculine folks agonizing about top surgery. It seems that many people just know they need to get something off their chests (or not). To that end, here are a few suggestions for those contemplating, planning and recovering from top surgery.

1. Pick a procedure. You are probably already looking into the available options. There are a few different procedures under the umbrella of top surgery for trans guys/transmasculine people. I had the double-incision with nipple grafts, a great option for people with a medium-to-large chest. I am very happy with the results. Smaller guys often opt for the periareolar procedure, which results in less scaring. There are also a few other options and a number of possible variations on these. This site has detailed info on procedures and other topics. A few things to consider when selecting a procedure:

What’s suggested for your chest size/shape?

Is nipple sensation important to you?

How do you feel about scarring?

Surgeons often specialize in one or two procedures, so you might want to choose your doctor based on specialty (if you know what you want) or choose your procedure based on the surgeon’s strengths (if you are seeing a specific doctor due to location, insurance coverage or preference). When comparing photos of procedure results, it’s important to look for folks who look like you. In addition to the size of your chest, your overall body shape and size, skin tone and other factors come into play.

2. Select a surgeon. Here again, you’re probably already doing research. If you’re not sure where to start, try browsing photos on transbucket and asking other trans people. Before moving forward with any surgeon, you should see photographs of their work and make sure other trans people have hade a good experience with them. If you are looking to change your gender marker to M, ask whether the surgeon will write you a letter stating you have had irreverisble gender confirmation surgery (or whatever language is required in your area). Another important factor is location–if there are any qualified surgeons in your area, you can save a lot of money by recovering at home.

I got my surgery from Dr. Daniel Medalie. This took me far from home, but it was a great choice for me. There are no surgeons specializing in chest reconstruction in my area, and Dr. Medalie is highly skilled, relatively affordable, and great with trans patients. He told me he does top surgery several times a week!

3. How the hell do I pay for this? Cost is a major concern when it comes to top surgery. If you live in the US (can’t speak to other countries), you will probably find yourself paying out of pocket. The surgery itself usually costs somewhere in the range of $6000-$8000. That number can skyrocket if you need to travel, pay for a place to stay while recovering, etc.

Many doctors offer payment plans or accept credit cards. I covered most of my surgery costs using a CareCredit card (a credit card just for medical expenses). I was lucky to get extensive help from my parents, and we paid it off within a few years. Many trans people raise money through donations or a benefit event. This is usually the hardest part, and of course it really depends on your situation. Don’t lose hope–you can find a way to make this happen.

Yours truly, 3.5 years post-op. My nipples were a lighter shade of brown before surgery–no idea what’s up with that. I think Dr. Medalie does a great job placing the incisions so that the scars fit in very naturally. Thanks to Alma for taking the photo.

4. Waiting is the hardest part. You’ve worked your ass off, come up with some serious cash, scheduled your surgery, requested time off work…. Now it’s time to sit back and wait six months til the surgery date. Ahhhh! This phase of the process nearly drove me insane. Every day I had to put my binder back on, I cursed time itself. I tormented Alma with an incessant countdown updated several times a day.

I made myself totally miserable. Don’t be like me! Come up with some things you can do to make waiting easier. You might allow yourself a special indulgence during this limbo period or find a way to mark the time that’s actually enjoyable.

5. Get help while healing. In general, you can expect to be thoroughly laid up for about a week, and then functional, but still tender and healing, for a month or two. If at all possible, have somebody available to care for you during that first week. You are going to feel like shit, and it is really helpful if someone can feed you, take you to your follow-up appointments, and so on. Huge thanks to Alma and my mom for taking excellent care of me during my recovery.

The worst part of the recovery for me actually came from the presciption painkillers. I really needed them for the first day or two. By about day three, I started to feel horrible–a miserable nausea and weakness like nothing else. My mom suggested I ditch the percoset and start taking ibuprofen. Once the hard stuff was out of my system, I felt amazing. I was practically skipping when I went in for my follow-up a week after surgery.

6. Scars–a conversation piece? How will you navigate being a person with surgical scars? Some people opt to cover their chests at the beach and the gym to avoid revealing their scars. Personally, I take my shirt off at the slightest excuse. I’ve found that people very rarely say anything about my scars or even seem to notice them. I’ve occasionally had someone ask if I had a collapsed lung or heart surgery. As far as I know, I’ve never had anyone guess that I am trans based on my scars. So I wouldn’t stress too much about people seeing the scars or commenting on them.

That said, it’s a good idea to have a game plan. If someone asks, what will you tell them, and how much? I usually just say something about how I had surgery a few years ago and leave it at that. People are too polite to pry further.

7. Enjoy yourself. The most important part of getting top surgery–enjoying the results! Throwing on a t-shirt without having to scrutinize your chest in the mirror. The feeling of a summer breeze on your skin. Swimming bare-chested. Never wearing a suffocating torture device binder ever again. Freedom is so sweet.

Readers–what tips do you have for someone preparing for top surgery? If you are considering or planning surgery, what questions do you have?

We have to get out of this idea that trans=a particular style of transition.

There is no point at which we become transgender – it isn’t because you have changed your name, or taken hormones, or had surgery, or legally changed your gender markers. You were transgender before you started your transition, you’d still be transgender if you never transitioned. If you feel that you are not authentically the “sex you were assigned at birth” then you are trans.

I love this apt reframing of what it is to be trans. Jamie Ray’s words are a powerful case for solidarity and respect among diverse transgender people. They are also an antidote to the some of that crippling shame we so often feel as we attempt to be our whole selves.

I talk about my transition in the language of choice, and I have made choices. Yet that’s really beside the point, isn’t it? Whatever gender my ID says, whatever clothes I wear, whatever medical treatments I have–I’m trans, and I always will be.

My transition has gotten to a point now where the steps I desperately wanted are behind me. But loose ends remain. I’m moving step by step towards getting a hysterectomy, at the suggestion of my doctor and pleading of my mother, because of the unknown risks of living with male hormones and female internal reproductive organs. I’m less than thrilled about the prospect.

I recently found myself thinking, If only it weren’t my choice, I could accept it. Somehow I feel I got myself here, I am to blame, and now I have to make this difficult decision. I don’t even want the stupid organs–I just don’t want to be responsible for choosing to remove them.

It isn’t my choice, though, not really. I am choosing to take care of my health. That’s a choice I can feel good about. But all the other stuff, the stuff I sometimes feel really bad about, is no choice and is not affected by choices. I didn’t choose to be a guy who was born with ovaries. I didn’t choose to not produce enough testosterone. I didn’t choose to be a member of a group whose health the system blatantly ignores.

I am trans. I was before I started transition, and I will be til the day I die. No choice I can make will ever change or “fix” that. And by the same token, no choice of mine caused it, nor could have ever caused it.

In other words, I didn’t choose the situation. Observing the situation, my course of action is a simple thing. We make our choices within limits entirely outside of our control. One more reason to respect each person’s unique journey. And a reason, too, to give ourselves our full permission to do what we have to do. We’re doing our best with what we’ve got. What we’ve got is what we’ve got, and nothing more–not a reflection on us.

Sometimes the personal is political. Sometimes the personal isn’t even personal.

I’m planning to get a hysterectomy fairly soon. I always knew this would be part of my transition. Now that I’m here, it’s more difficult than I thought it would be.

It makes being trans much more real. I am a man who was born with a uterus and ovaries. What the fuck, God? It feels like a head-on collision with the absurdity of life.

I have always wanted to have a family. I feel a profound longing to be a parent, and I have for my whole life. I don’t feel strongly that I want to be a biological parent specifically, and I don’t want to use what I was born with. Still, there’s something really sad about surgical sterilization at the age of 24. I feel shut out of an important experience that other people take for granted. I know that many people can’t have biological children, but nobody talks about it.

My fiancée and I want to adopt. I am terrified we will face discrimination that will make that impossible. I am not interested in reproductive technologies, for a variety of reasons. I have been fortunate to meet a number of trans people who are parents, but none who have adopted.

There are some major silver linings here, of course. I won’t have to worry about the elevated cancer risk I may have as a transsexual man (the reason my doctor recommends hysterectomy). I won’t have any female-specific health care needs. I will have an excuse to lay around watching movies for a week. And I think I will feel a satisfying peace that my transition is complete.

So it’s not that I don’t want a hysterectomy–it’s that I wish I didn’t need one.

These were the words I’d been waiting to hear my whole life. Said by the person I’d always wanted to say them. Unfortunately, when my mother finally spoke those words, I wasn’t there to hear it. I was a hundred yards away and under general anesthesia.

My girlfriend, now fiancée, was the one who heard them. She told me later, back in our hotel room. While my chest was being reconstructed, the two women in my life had gotten to know each other better.

Alma and I had only been together for six months. It seemed perfectly natural she’d accompany us to Cleveland to help take care of me after my surgery. My mom cooked; Alma cleaned my drains full of blood and pus. Her tender care and steel stomach made quite an impression on both my mother and me.

While I was in surgery, Alma was overcome with worry. True to form, my mother tried to feed her. And she told her things about me–some she’d told me before, and some she never had.

Things I already knew: That there was always something different about me. That they’d been really worried about me and were relieved I was doing so well since starting transition.

Things I didn’t know: That she noticed I was masculine from the time I was a tiny child. That I always had a masculine look. Square jaw, muscular limbs, broad shoulders. She said I looked like a little linebacker. She said she knew there was something there, and it seems so obvious now–but at the time, she just didn’t connect the dots. Remorse ran off her voice, rainwater in a gutter.

It was a great gift to get this information, no matter how indirectly. Some thunderstorm in my heart finally went quiet, a temper tantrum I’d been waging for twenty years resolved at last. Like when the heater turns off and you’re suddenly aware it had been humming in your head for hours. Like the first day you wake up feeling better from the flu. You remember what it’s like to feel good.

Then I understood why she’d never told me. My parents bit their tongues on the very words I needed to hear the most. They thought those words would crush me. They thought they’d be calling me ugly. Now they know they were wrong.

They had probably never met a transgender person. They’d certainly never been parents before. This year I’ll be as old as my father was when I was born.

It recently occurred to me that, although I have not had genital surgery, in a lot of ways, I no longer feel like someone who has not had genital surgery. I have had surgery once as part of my transition (chest reconstruction) and plan to have surgery once more (hysterectomy, at my doctor’s recommendation). If you had asked me early in my transition, I would have said I wanted to have bottom surgery (probably metoidioplasty) as soon as possible.

What’s changed? Going into this journey, I underestimated two things: how much other transition steps would affect my relationship with my whole body, and how much surgery sucks.

Let’s take the unpleasantness of surgery first. Chest surgery was a great experience–if I had to, I would make that decision again in a heartbeat. It was also a reality check. Pain, recovery time, needing help while healing, taking medications, going under anesthesia, numbness and scarring–all these things real to me now. I have also felt the impact of the financial costs. If genital surgery procedures were comparable to chest surgery in terms of risks and costs–including healing time, dangers of any surgery, possible loss of sensation, dollar cost, etc.–I might consider it. But that’s not the case. Bottom surgery is more dangerous and much more expensive, healing times are much longer, and I would likely need multiple procedures. Considering the price-tag, healing time, and other risks of bottom surgery, it’s just not worth it to me.

It probably would be worth it to me, though, if I still experienced acute dysphoria. That brings me to the other thing I underestimated–how big a difference all the other aspects of my transition have made.

I am now able to move through the world as a man with ease. I am able to feel comfortable during sex. I still have some dysphoria, and it’s not pleasant, but I think it’s now within the range of ordinary body image insecurity that many people experience. I’d say I’ve gone from a 10 to a 2 on a 10-point gender dysphoria scale.

I also underestimated, quite literally, the changes testosterone would cause when it comes to my dick. I had extreme dysphoria around my genitals pre-T. I considered myself stone and always used a strap-on during sex. This has totally reversed–today, using any kind of prosthesis would induce dysphoria, not alleviate it. Though my genital configuration is definitely not average, I am able recognize what I have as male. I have a dick, plain and simple. I still experience dysphoria around that part of my body, but it is manageable.

I also have a partner who perceives my body as male, and I am able to engage sexually in a way that feels right to me–to have intercourse and do all the other fun stuff straight dudes tend to do. I did not know that would happen, and I did not know how much it would mean to me.

Pretty much the only thing I can’t do is pee standing up in a convenient, splash-free fashion. From my observations in public restrooms, it appears that a large proportion of men have this problem.